Patient H.C.: 177464

A 7 years old female, with a history of
vomiting and recurrent abdominal pain. Had been
hospitalized for two occasions before final diagnosis. Fist
time for vomiting in association with a mild head trauma.
Second time dismissed with diagnosis of Upper Airway infection.

Mother described the problem as recurrent
abdominal pain that disappeared spontaneously most of the time,
in some occasions presented with bilious vomiting.

At examination patient presented a mild
abdominal pain, vomiting 6 in 24 hours (bilious). No
abdominal distention was present. Pain was colic, and
disappeared after a couple of days, presenting itself again
after 24 hours.

Pre operative X Ray
images:

Fig 1: Non rotated Doudenum

Fig 2: Non rotated Colon

Fig. 3: Heart to the right on chest X ray.

Operation findings:

Fig. 4.- Volvulus of the midgut. Colon and Duodenum are seen
on the contrary side of their usual presentation for this type of
problem.

Torsion of the mesentrery rooth was counterclockwise, volvulus
was untwisted in a clockwise direction.

Fig. 5 and 6.- One can apreciate that findings of Colon to the
right of patient and Doudenum to the left, correspond exactly to
a mirror image of the
scheme for reduction of volvulos, taken from "Malrotation of
the Intestine. Alexander H. Bill. Pediatric Surgery 3erd Edition
p.918. Year Book Medical Publishers 1979.

Fig. 7.- Once the volvulus was reduced, non rotation of both
Colon and Duodedenum was evident, with a narrow mesentery base.

Fig. 8 and 9.- Using again the figures in the chapter of Bill,
we can see that the desrotated intestine correspond exactly to a mirror image of the Type 1A of
the Classification of Snyder and Chaffin.

Thus we woudl like to call this situation Intestinal
Malrotation Type 1-A inversa